Healthcare Provider Details

I. General information

NPI: 1336257922
Provider Name (Legal Business Name): DONNA BYRNES WALSH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOOTHILL BLVD 3-WEST
SALT LAKE CITY UT
84148-0001
US

IV. Provider business mailing address

8893 QUAIL HOLLOW DR
SANDY UT
84093-1907
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-1565
  • Fax: 801-584-5646
Mailing address:
  • Phone: 801-942-7475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number293917-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: